Educational Requirements

• High school diploma
• Knowledge of CPT and ICD-10 diagnosis highly desired
• Knowledge of Medicare and third party payer regulations and guidelines highly desired
• Proficiency in PC software, especially word processing and spreadsheet programs
• Experience with patient billing software preferred; eCW software particularly helpful
• Effective communication skills, both written and verbal
• Ability to work independently, multi-task, problem-solve, and meet deadlines
• Strong organizational skills
• Effective interpersonal skills

Role and Responsibilities

• Serve as principal contact for clinic and/or department staff regarding prior authorization process for services to be rendered at the clinics
• Understand insurance requirements for prior authorization.
• Serve as primary resource to clinic regarding the prior authorization requirements, especially for Modern Vascular most common payers
• Knowledge and understanding of co-insurance, co-payments, deductible, and out-of-pockets
• Collect clinical information regarding service to be rendered, using ECW and/or paper medical records, as well as interacting directly with providers and/or their clinical staff.
• Contact payer to obtain prior authorization. Gather additional clinical and/or coding information, as necessary, in order to obtain prior authorization. Enter prior authorization information into ECW to ensure accurate and timely claims filing
• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization. If necessary, notify Billing of uninsured situations
• Stay informed and research information regarding new procedures and insurance coverage positions. 7. Serve as primary resource to patients regarding prior authorization process. Explain requirements, terminology, billing process, consent requirements, collect insurance info, etc., as necessary
• Verify that all insurance requirements for outpatient procedures have been met
• Educate providers and their clinical staff regarding the prior authorization process
• In eClinicalworks: o Enter “Auth Type” in the referral module o Under “Notes” enter patient’s benefits” in the referral module
• Perform other duties, as assigned.

The duties and responsibilities in this job description may be subject to change. Management may, at its discretion assign or reassign duties due to reasonable accommodation or other reasons.